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BLOOD FLOW RESTRICTION IN PHYSICAL THERAPY

by / Friday, 26 January 2018 / Published in Articles, Physical Therapy

WHAT IS BLOOD FLOW RESTRICTION (BFR)?
Blood flow restriction training (BFR) was first introduced in 1966, originally popularized as “Kaatsu training” before taking the general name of BFR. It was primarily used among powerlifters and
bodybuilders to increase strength and muscle hypertrophy. However, in recent years, research supports the use of BFR in the rehabilitation populations.
BFR is a tool that restricts venous blood flow return, which aids in lowering the mechanical stress needed for muscle hypertrophy and strength gains. Research has shown that BFR training loads at or below 50% of 1-RM, even to as low as 20-30%, improving muscle strength and hypertrophy gains. BFR training focuses on the metabolic aspect of strength training and allows for strength gains at much lower intensities. This allows for early optimal loading intervention for healing tissue that is not capable of sustaining the higher loads necessary for full recovery. To put this in perspective, a straight leg raise exercise with BFR, while allowing tissues to heal, is comparable to a traditional body weight squat.

HOW DOES BFR WORK?
There are two primary triggers to create physiological changes in muscle strength and hypertrophy. First, mechanical stress and second, metabolic stress. After acute or repeated bouts of appropriate mechanical stress to the muscles that exceeds tissue capacity, IGF-1 and mTOR hormones are released, which are the driving force of muscle growth and hypertrophy. When triggered, it Blood Flow Restriction Training-Image1 sends a cascade effect that activates satellite cells in the sarcolemma to proliferate and bind to the muscle cells to create new muscle fibers. To make strength and muscle hypertrophy gains through mechanical stress, one must work at or above 65% of their 1- Rep Max (RM), with adaptation time ranging between 8-12 weeks. In the rehabilitation population, patients often do not tolerate this 65% of 1 RM load. Post-surgical patients may not even be allowed to perform resistant training exercises for several weeks due to surgical precautions.
BFR training with the use of pneumatic tourniquets allows for arterial blood flow to a region while restricting venous blood flow return. This restriction creates a more robust anabolic environment for muscle growth and strength during rest periods, without joint stress or damage to non-contractile tissue.

BENEFITS
It has been demonstrated that BFR training increases the endocrine response and release of hormones such as GH and IGF-1, needed for protein synthesis, by 200-300%. This heightens the cell
signaling for hypertrophy and strength gains. GH also supports the building of non-contractile tissues which is needed after surgery or a severe injury. Some other key benefits of BFR training include; a decrease in pain perception up to 24 hours after use, aid in tissue repair, activation of new blood vessel growth, increased recruitment of anaerobic muscle fibers, and an increase in angiogenesis. BFR is a safe alternative to traditional resistance training by allowing up to 50% less in exercise intensity in order to gain similar physiological results. This plays a significant role in achieving the necessary functional gains in the aging or injured population.

INDICATIONS OF USE
The patient populations appropriate for the use of BFR training include:
• Prehab/ Rehab – Injuries including sprains/ strains, Osteoarthritis, post-op patients such as
TKA , ACL’s , RTC Repair, non-weight bearing patients. It is ideal for the patient needing early
strength gains to improve function, while minimizing the mechanical stress to the muscle and
joint.
• Athletes and Strength Training – May be used during rest days to reduce mechanical load on
muscles but continue to make strength gains.
• General Population -Walking endurance and strength training for the aging population,
depending on health status and clinical presentation.

CONTRAINDICATIONS OF USE
There are specific precautions to BFR training that must be adhered to. It is vital that a clinical prediction rule that combines medical signs, symptoms and clinical findings that predict success or failure of this procedure is know by the clinician. Below is a list of key contraindications:
Venous thromboembolism, impaired circulation or peripheral vascular compromise, previous revascularization of the extremity, extremities with dialysis access, acidosis, sickle cell anemia, Blood Flow Restriction Training-Image2 extremity infection, tumor distal to the tourniquet, medications and supplements with known clotting risks, open fracture, open soft tissue injuries, post-traumatic lengthy hand reconstructions, severe crushing injuries, severe hypertension, skin grafts in which all bleeding points must be readily distinguished, vascular grafting, and cancer.

CONCLUSION
BFR venous return restriction has substantial benefits within the physical therapy practice. It allows for early optimal loading interventions for healing tissue that cannot sustain the necessary higher loads that are needed for safe and quick recovery, while minimizing injury to healing tissue.
At Wright Physical Therapy, we are committed to your patient’s success and the discovery of new and innovative solutions to help in full recovery of function. Please email Dr. Sylvan Johnson (sylvan@wrightpt.com) or Dr. Kelson Richards (kelson@wrightpt.com) with any questions, or call us
at any one of our six Magic Valley locations or our new Idaho Falls Location.

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